Complications and Neurological Outcome following Intraoperative Aneurysm Rupture in Adult Patients Undergoing Intracranial Aneurysmal Clipping: A Retrospective Study

Efficacy of minimally invasive hematoma evacuation in treating traumatic intracranial hematoma: a retrospective cohort study

OBJECTIVE

This study aimed to evaluate the clinical efficacy and safety of minimally invasive hematoma evacuation for the treatment of traumatic intracranial hematoma (TIH).

METHODS

Ninety patients diagnosed with traumatic intracerebral hematoma at Shengli Oilfield Central Hospital from August 2019 to September 2023 were selected as the study subjects. The patients were divided into the craniotomy group (C group, n = 45) and the minimally invasive hematoma evacuation group (MIHE group, n = 45). Patients in group MIHE were treated with minimally invasive hematoma evacuation according to the amount and location of the TIH. The patients' baseline characteristics, the good prognosis rate, the neurological function index, the hospitalization cost and the incidence rate of complications were compared between the two groups. The status of the patients after surgical treatment was determined according to the Glasgow Outcome Scale.

RESULTS

The good prognosis rate in the MIHE group (39, 86.67%) was significantly higher than that in the C group (31, 68.89%) (p < 0.05). National Institute of Health stroke scale (NIHSS) scores were significantly lower in the MIHE group than in the C group (p < 0.05). The hospitalization cost and hospitalization time in the MIHE group were significantly lower than those in the C group (p < 0.05). The total incidence rate of complications in the MIHE group (20, 44.44%) was significantly lower than that in the C group (11, 24.44%) (p < 0.05).

CONCLUSION

For some patients, minimally invasive hematoma evacuation is a more effective treatment strategy than craniotomy for patients with TIH. It has the advantages of less surgical trauma, complete clearance of hematoma and fewer postoperative complications, which is conducive to the recovery of neurological function and postoperative rehabilitation.

Clinical Characteristics and Outcome of Patients With Intraoperative Aneurysm Rupture: A Retrospective Cohort Study From Nepal

BACKGROUND AND OBJECTIVES

Intraoperative aneurysm rupture (IAR) is a significant complication during microsurgical clipping of cerebral aneurysms. The timing of rupture during surgery, morphology of the aneurysm, and strategies to mitigate risk are the key factors that influence the outcome.

METHODS

Consecutive patients with the diagnosis of ruptured cerebral aneurysms were retrospectively reviewed at a single University Hospital in Kathmandu, Nepal. Variables analyzed included age, sex, presenting symptoms, Hunt and Hess grades, the location of aneurysms, the timing of surgery, and intraoperative rupture status. Outcomes were assessed at 6 months after surgery.

RESULTS

A total of 199 patients with 231 ruptured cerebral aneurysms from July 2014 to December 2022 were reviewed. Surgery was performed within 3 days in 60 (30.1%) patients. Twenty aneurysms ruptured intraoperatively in 20 patients (10% per patient and 8.6% per aneurysm). Patients with IAR were significantly younger (mean age 52 years) than those without IAR (mean age 58 years) (P < .001, 95% CI: 3.72-8.28). There was no difference in IAR rate in early vs late surgery. Anterior communicating artery complex aneurysms were noted as the most common. However, posterior inferior cerebellar and posterior cerebral artery aneurysms had the highest IAR rate, albeit with the smallest total number. Rupture during dissection was noted in 10 (50%) and during clipping in 9 (45%) procedures. Strategies for handling IAR included direct definitive clip application in 9, temporary clip-aided permanent clipping in 8, and trapping of the parent vessel in 1 patient. Although postoperative complications were significantly higher in the IAR group (P < .000129), the neurological outcomes using the modified Rankin scale in 6 months were similar (P = .877).

CONCLUSION

The demographic and clinical characteristics and rates of IAR in our patient population are similar to those in the contemporary literature. In patients with IAR, the outcome is not worse than those without IAR.